SuperSlow® RoundTable Registration

There are three ways to register with this on-line registration form:

1.)  Online With Credit Card: Enter your information including your Credit Card information in the spaces below, and click SUBMIT.  This is the fastest way to register.  Note: Credit Card transactions will NOT be processed over the internet.  We will charge your credit card from our home office.

- OR -

2.)  Print & Fax With Credit Card: print and fax this form with your Credit Card information to:  407-292-9244.  When you hear the message, press the START key to send fax.  No cover sheet is needed, and the fax line is available 24 hours, 7 days a week.  Trouble faxing?  Please call Michael at 407-296-5269.

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3.)  Print & Mail With Check: print and mail this form with your Check to:

 

Gylanix Solutions

380 S. SR 434

Suite 1004 – 316

      Altamonte Springs, FL  32714

Check is made payable to Gylanix Solutions

I am: (Please check all that apply and fill in appropriate boxes)

A Fitness/Exercise Professional

 A SuperSlow® Guild Member
   Not A SuperSlow® Guild Member
 A fitness professional
 A professional trainer, for years (enter number)
 A fitness facility owner, for years (enter number)
 Planning to own a fitness facility in the future
 Both a professional trainer and facility owner, for years 
 A fitness/exercise professional (other than personal training)

A Health, Wellness, or Nutrition Professional

A medical professional
 A health professional
 A wellness/complementary medicine professional
 A nutrition professional

From the General Public

An educator,  teaching
A student,  studying
Interested in health, fitness and healthy lifestyles
 Other: 

Please email or call Roxie at 1(503) 463-0187 if you have any questions or need assistance with this form.


Note: Your credit card will be charged and will appear as Gylanix Institute on your credit card statement.

First Name 

Last Name

Title 

Company 

Address Line 1

Address Line 2

City

State

Zip

Country

Email (Required for Online Registration)

Day Phone (Req'd for Fax/Mail Registration)

Night Phone 

Fax 

Name On Credit Card

Credit Card #

CC Address If Different From Above

CC City If Different From Above

CC State If Different From Above

CC Zip If Different From Above

CC Country If Different From Above

Credit Card Exp. Date

Date(s) Registering For If Other Than Full Year

Amount Of Charge (From Table Below)

 $

 

Individual Guild Member Subscription

Annual Subscription
(12 RoundTables, one per month)

$150

One person on one conference bridge line.

Facility Subscription

Annual Subscription
(12 RoundTables, one per month)

$225

One conference bridge line per facility; several Instructors listening (speaker phone or multiple phones in the facility)

Individual Non-Guild Member Subscription

Annual Subscription
(12 RoundTables, one per month)

$190

One person on one conference bridge line.

Individual Tele-Conference

Per Individual RoundTable

$30 each

One person on one conference bridge line.

            

* Clicking "Submit" indicates that I understand that the my participation is to be respectful. This may include respectful disagreement and stimulating ideas that are thought-provoking.

 

 

FEE INCLUDES:
Entry to all SuperSlow® RoundTables to participate with speakers, facilitators and other participants.  Does not include long distance charge to call the conference bridge (a long distance charge that you pay for).

REFUND POLICY:
There is no refund for this program.

 

RoundTable Date and Times:
The second Thursday of each month, 2:00 – 3:00 pm ET. (Please convert the time to your time zone.)  See Schedule for exact dates.

 

Need assistance?   Call Roxie at  1(503) 463-0187.

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